Bidirectional interaction between heavy metals and intestinal microorganisms / 环境与职业医学

There is a bidirectional interactive relationship between heavy metals and intestinal microorganisms. Single exposure to common heavy metals (Cd, Cr, As, Pb, etc.) may cause intestinal microecological damage and related diseases by losing the diversity and relative abundance of intestinal microorganisms. However, heavy metals in the environment are usually mixed exposure and an overall toxic effect is presented. Published studies have suggested a synergistic effect between most heavy metals, so the impact of mixed exposure on intestinal microorganisms is expected to be more significant than that of single exposure. Intestinal microorganisms are the first line of defense against heavy metals entering the body, and can reduce inflammation and oxidation caused by heavy metals via changing protein synthesis, intestinal PH, enzyme activity, etc. At the same time, the colonization of oral probiotics in the intestinal tract has a significant detoxification effect on heavy metals entering the body through synergy with intestinal microorganisms, which can promote the elimination of heavy metals, reduce the production of oxides and inflammatory mediators, reverse the changes in the relative abundance of intestinal microorganisms, and then reduce the damage of heavy metals to intestinal microecology. Therefore, probiotics may have better prospects than traditional heavy metal antidotes. In the future, more in-depth research on the mechanism of bidirectional interactive relationship between heavy metals and intestinal microorganisms is needed to provide new ideas for clinical heavy metal detoxification.

Study on the general mental health status and influencing factors of Chinese Medical Team members / 中华流行病学杂志

Objective@#To analyze the mental health status of the Chinese Medical Team (CMT) members and its influencing factors.@*Methods@#A total of 1 015 members of the CMT were recruited and surveyed by using a self-administered questionnaire and 12-item General Health Questionnaire (GHQ-12) from May 10 to June 10, 2018. Multivariable logistic regression models were used to identify risk factors for mental health problems.@*Results@#A total of 808 subjects completed the questionnaire and an estimated 25.9% of them were suspected to have mental health problems (GHQ-12≥3). Logistic model analysis indicated that family life (OR=1.928, 95%CI: 1.162-3.197), domestic work status (OR=2.069, 95%CI: 1.210-3.538), father’s health status (OR=1.703, 95%CI: 1.060-2.736), disease symptoms (OR=2.087, 95%CI: 1.363-3.194), captain (OR=1.996, 95%CI: 1.128-3.532), cultural differences (OR=2.439, 95%CI: 1.621-3.671) were the risk factors for mental health. Age (OR=0.736, 95%CI: 0.571-0.949), leisure activities (OR=0.654, 95%CI: 0.490-0.872) were the protective factors. Drinking habits (OR=7.439, 95%CI: 1.290- 42.900), loneliness (OR=4.094, 95%CI: 2.438-6.875), and respect from the hospital (OR=0.783, 95%CI: 0.610-1.004) were relative to mental health problems.@*Conclusion@#CMT members have certain mental health problems, especially young members and captains. Therefore, interventions should be implemented to improve the mental health of CMT members and to promote the development of foreign aid work.

Application and evaluation of signal strength indictor in communicable disease automatic early warning system / 中华预防医学杂志

<p><b>OBJECTIVE</b>To explore the effect of signal strength indictor (SSI) in improving sensitivity of China Infectious Diseases Automated-alert and Response System (CIDARS).</p><p><b>METHODS</b>Diarrhea cases in 2007-2011 and early warning signals in 2010-2011 were selected by using random digital table method. Then, SSI and event-related ratio (ER) were calculated. The relationship between ER and SSI was analyzed, and the effect of SSI on ER was explored by using multiple logistic regression analysis.</p><p><b>RESULTS</b>9 620 early warning signals in 2010-2011 were generated in two years. Of these, 74, or 0.77% were defined as suspected outbreak signal. The median of SSI related with suspected outbreak signal was 4.0, which was much higher than non-suspected outbreak signal (1.7). ER was significantly correlated with SSI (r=0.917). SSI classification has a good correlation between the ER, ER exceeded 20 after SSI reached 20. The multivariate logistic regression analysis showed OR of SSI related with suspected outbreak signal was 2.52 (95% CI 2.04-3.12). Compared with non-epidemic season, the relationship of SSI and ER in epidemic season was much higher.</p><p><b>CONCLUSION</b>SSI was closely related with ER. The relationship was much closer in large scale outbreak and epidemic season, and compared to non-epidemic,the effect of epidemic season is more obvious.</p>

Viral etiologies of hospitalized pneumonia patients aged less than five years in six provinces, 2009-2012 / 中华流行病学杂志

Objective To analyze the viral etiologies of hospitalized pneumonia patients aged less than five years in six provinces during 2009-2012,and to describe the seasonality of the detected viral etiologies. Methods Eight hospitals were selected in six provinces from a national acute respiratory infection surveillance network. Demographic information,clinical history and physical examination,and laboratory testing results of the enrolled hospitalized patients aged less than five years with pneumonia,including respiratory syncytial virus (RSV),human influenza virus, adenoviruses(ADV),human parainfluenza virus(PIV),human metapneumovirus(hMPV),human coronavirus(hCoV)and human bocavirus(hBoV)were analyzed. The viral etiology spectrum of the enrolled patients was analyzed by age-group,year,and seasonality of the detected viral etiologies were described. Results 4 508 hospitalized children less than five years old,with pneumonia from 8 hospitals were included,and 2 688(59.6%)patients were positive for at least one viral etiology. The most frequent detected virus was RSV(21.3%),followed by PIV(7.1%)and influenza(5.2%),hBoV (3.8%),ADV(3.6%)and hMPV(2.6%). The lowest positive rates in hCoV(1.1%). RSV,influenza, PIV,hBoV and hMPV all showed the nature of seasonality. Conclusion RSV was a most common viral etiology in the hospitalized young children less than 5 years of age with pneumonia. Prevention measures should be conducted to decrease its severe impact to the young infants and children in China.

Viral etiologies of hospitalized pneumonia patients aged less than five years in six provinces, 2009-2012 / 中华流行病学杂志

Objective To analyze the viral etiologies of hospitalized pneumonia patients aged less than five years in six provinces during 2009-2012,and to describe the seasonality of the detected viral etiologies. Methods Eight hospitals were selected in six provinces from a national acute respiratory infection surveillance network. Demographic information,clinical history and physical examination,and laboratory testing results of the enrolled hospitalized patients aged less than five years with pneumonia,including respiratory syncytial virus (RSV),human influenza virus, adenoviruses(ADV),human parainfluenza virus(PIV),human metapneumovirus(hMPV),human coronavirus(hCoV)and human bocavirus(hBoV)were analyzed. The viral etiology spectrum of the enrolled patients was analyzed by age-group,year,and seasonality of the detected viral etiologies were described. Results 4 508 hospitalized children less than five years old,with pneumonia from 8 hospitals were included,and 2 688(59.6%)patients were positive for at least one viral etiology. The most frequent detected virus was RSV(21.3%),followed by PIV(7.1%)and influenza(5.2%),hBoV (3.8%),ADV(3.6%)and hMPV(2.6%). The lowest positive rates in hCoV(1.1%). RSV,influenza, PIV,hBoV and hMPV all showed the nature of seasonality. Conclusion RSV was a most common viral etiology in the hospitalized young children less than 5 years of age with pneumonia. Prevention measures should be conducted to decrease its severe impact to the young infants and children in China.

Viral etiologies of hospitalized pneumonia patients aged less than five years in six provinces, 2009-2012 / 中华流行病学杂志

<p><b>OBJECTIVE</b>To analyze the viral etiologies of hospitalized pneumonia patients aged less than five years in six provinces during 2009-2012, and to describe the seasonality of the detected viral etiologies.</p><p><b>METHODS</b>Eight hospitals were selected in six provinces from a national acute respiratory infection surveillance network. Demographic information, clinical history and physical examination, and laboratory testing results of the enrolled hospitalized patients aged less than five years with pneumonia, including respiratory syncytial virus (RSV), human influenza virus, adenoviruses (ADV), human parainfluenza virus (PIV), human metapneumovirus (hMPV), human coronavirus (hCoV)and human bocavirus (hBoV) were analyzed. The viral etiology spectrum of the enrolled patients was analyzed by age-group, year, and seasonality of the detected viral etiologies were described.</p><p><b>RESULTS</b>4 508 hospitalized children less than five years old, with pneumonia from 8 hospitals were included, and 2 688 (59.6%) patients were positive for at least one viral etiology. The most frequent detected virus was RSV (21.3%), followed by PIV (7.1%) and influenza (5.2%), hBoV (3.8%), ADV(3.6%) and hMPV(2.6%). The lowest positive rates in hCoV(1.1%). RSV, influenza, PIV, hBoV and hMPV all showed the nature of seasonality.</p><p><b>CONCLUSION</b>RSV was a most common viral etiology in the hospitalized young children less than 5 years of age with pneumonia. Prevention measures should be conducted to decrease its severe impact to the young infants and children in China.</p>

The implement performance of China Infectious Diseases Automated-alert and Response System in 2011-2013 / 中华预防医学杂志

<p><b>OBJECTIVE</b>To analyze the implement performance of China Infectious Diseases Automated-alert and Response System (CIDARS) of 31 provinces in mainland China, and to provide the evidences for further promoting the application and improvement of this system.</p><p><b>METHODS</b>The amount of signals, response situation and verification outcome of signals related to 32 infectious diseases of 31 provinces in mainland China in CIDARS were investigated from 2011 to 2013, the changes by year on the proportion of responded signals and timeliness of signal response were descriptively analyzed.</p><p><b>RESULTS</b>A total of 960 831 signals were generated nationwide on 32 kinds of infectious diseases in the system, with 98.87% signals (949 936) being responded, and the median (the 25(th) percentile to the 75(th) percentile (P25-P75) ) of time to response was 1.0 (0.4-3.3) h. Among all the signals, 242 355 signals were generated by the fixed-value detection method, the proportion of responded signals was 96.37% (62 349/64 703), 98.75% (68 413/69 282) and 99.37% (107 690/108 370), respectively, and the median (P25-P75) of time to response was 1.3 (0.3-9.7), 0.8(0.2-4.9) and 0.7 (0.2-4.2) h, respectively. After the preliminary data verification, field investigation and laboratory test by local public health staffs, 100 232 cases (41.36%) were finally confirmed.In addition, 718 476 signals were generated by the temporal aberration detection methods, and the average amount of signal per county per week throughout the country were 1.53, and 8 155 signals (1.14%) were verified as suspected outbreaks. During these 3 years, the proportion of signal response was 98.89% (231 149/233 746), 98.90% (254 182/257 015) and 99.31% (226 153/227 715), respectively, and the median (P25-P75) of time to response was 1.1 (0.5-3.3), 1.0 (0.5-2.9) and 1.0 (0.5-2.6) h, respectively.</p><p><b>CONCLUSION</b>From 2011 to 2013, the proportion of responded signals and response timeliness of CIDARS maintained a rather high level, and further presented an increasing trend year by year. But the proportion of signals related to suspected outbreaks should be improved.</p>

Comparing the performance of temporal model and temporal-spatial model for outbreak detection in China Infectious Diseases Automated-alert and Response System, 2011-2013, China / 中华预防医学杂志

<p><b>OBJECTIVE</b>For providing evidences for further modification of China Infectious Diseases Automated-alert and Response System (CIDARS) by comparing the early-warning performance of the temporal model and temporal-spatial model in CIDARS.</p><p><b>METHODS</b>The application performance for outbreak detection of temporal model and temporal-spatial model simultaneously running among 208 pilot counties in 20 provinces from 2011 to 2013 was compared; the 16 infectious diseases were divided into two classes according to the disease incidence level; cases data in nationwide Notifiable Infectious Diseases Reporting Information System was combined with outbreaks reported to Public Health Emergency Reporting System, by adopting the index of the number of signals, sensitivity, false alarm rate and time for detection.</p><p><b>RESULTS</b>The overall sensitivity of temporal model and temporal-spatial model for 16 diseases was 96.23% (153/159) and 90.57% (144/159) respectively, without significant difference (Z = -1.604, P = 0.109), and the false alarm rate of temporal model (1.57%, 57 068/3 643 279) was significantly higher than that of temporal-spatial model (0.64%, 23 341/3 643 279) (Z = -3.408, P = 0.001), while the median time for detection of these two models was not significantly different, which was 3.0 days and 1.0 day respectively (Z = -1.334, P = 0.182).For 6 diseases of type I which represent the lower incidence, including epidemic hemorrhagic fever,Japanese encephalitis, dengue, meningococcal meningitis, typhus, leptospirosis, the sensitivity was 100% for both models (8/8, 8/8), and the false alarm rate of both temporal model and temporal-spatial model was 0.07% (954/1 367 437, 900/1 367 437), with the median time for detection being 2.5 days and 3.0 days respectively. The number of signals generated by temporal-spatial model was reduced by 2.29% compared with that of temporal model.For 10 diseases of type II which represent the higher incidence, including mumps, dysentery, scarlet fever, influenza, rubella, hepatitis E, acute hemorrhagic conjunctivitis, hepatitis A, typhoid and paratyphoid, and other infectious diarrhea, the sensitivity of temporal model was 96.03% (145/151), and the sensitivity of temporal-spatial model was 90.07% (136/151), the number of signals generated by temporal-spatial model was reduced by 59.36% compared with that of temporal model. Compared to temporal model, temporal-spatial model reduced both the number of signals and the false alarm rate of all the type II diseases;and the median of outbreak detection time of temporal model and temporal-spatial model was 3.0 days and 1.0 day, respectively.</p><p><b>CONCLUSION</b>Overall, the temporal-spatial model had better outbreak detection performance, but the performance of two different models varies for infectious diseases with different incidence levels, and the adjustment and optimization of the temporal model and temporal-spatial model should be conducted according to specific infectious disease in CIDARS.</p>

Analysis of effect on infectious diseases outbreak detection performance by classifying provinces for moving percentile method / 中华预防医学杂志

<p><b>OBJECTIVE</b>Providing evidences for further modification of China Infectious Diseases Automated-alert and Response System (CIDARS) via analyzing the outbreak detection performance of Moving Percentile Method (MPM) by optimizing thresholds in different provinces.</p><p><b>METHODS</b>We collected the amount of MPM signals, response results of signals in CIDARS, cases data in nationwide Notifiable Infectious Diseases Reporting Information System, and outbreaks data in Public Health Emergency Reporting System of 16 infectious diseases in 31 provinces in Chinese mainland from January 2011 to October 2013. The threshold with the optimal sensitivity, the shortest time to detect outbreak and the least number of signals was considered as the best threshold of each disease in Chinese mainland and in each province.</p><p><b>RESULTS</b>Among all the 16 diseases, the optimal thresholds of 10 diseases, including dysentery, dengue, hepatitis A, typhoid and paratyphoid, meningococcal meningitis, Japanese encephalitis, scarlet fever, leptospirosis, hepatitis, typhus in country level were the 90(th) percentile (P90), which was the same as provincial level for those diseases.For the other 6 diseases, including other infectious diarrhea, influenza, acute hemorrhagic conjunctivitis, mumps, rubella and epidemic hemorrhagic fever, the nationwide optimal thresholds were the 80th percentile (P80), which was different from that by provinces for each disease. For these 6 diseases, the number of signals generated by MPM with the optimal threshold for each province was decreased by 23.71% (45 557), 15.59% (6 124), 14.07% (1 870), 9.44% (13 881), 8.65% (1 294) and 6.03% (313) respectively, comparing to the national optimal threshold, while the sensitivity and time to detection of CIDARS were still the same.</p><p><b>CONCLUSION</b>Optimizing the threshold by different diseases and provinces for MPM in CIDARS could reduce the number of signals while maintaining the same sensitivity and time to detection.</p>